The following common therapies are used to treat NHL. Consult with your health care team to discuss the best treatment options for your disease.
Chemotherapy uses drugs to destroy cancer cells. Most people treated for cancer receive some kind of chemotherapy. Side effects will vary depending on the type, dose, and frequency of the drug or drug combination you receive.
Chemotherapy can destroy cancer cells, but it can also destroy normal cells. It is given through a vein, as a shot, or taken in pill form. Chemotherapy is usually given in cycles, which means you may receive treatment for several weeks then take a break for your body to recover. A common chemotherapy drug regimen for NHL is called CHOP, which includes:
- cyclophosphamide (Cytoxan®)
- doxorubicin (hydroxydoxorubicin)
- vincristine (Oncovin®)
- Rituximab (Rituxan®) and its biosimilar rituximab-abbs (Truxima®), – Although it is classified as a type of immunotherapy it is often added to this chemotherapy regimen.
Treatment for B-cell lymphomas usually also includes targeted medication rituximab (Rituxan®). This drug binds to a marker on the outside of the B-cells. Since this medication was approved, patient outcomes have significantly improved in B-cell lymphomas. When rituximab is added to CHOP, it is called R-CHOP. Sometimes, other targeted medications similar to Rixutan are used, such as obinutuzumab (Gazyva), or ofatumumab (Arzerra).
Stem Cell Transplant
Stem Cell Transplants are sometimes used to treat NHL. This treatment is seldom recommended for newly diagnosed lymphomas. In a transplant, the stem cells are removed from the patient’s blood or bone marrow then frozen and stored. Very high doses of chemotherapy, with or without radiation therapy, are then given in order to kill the cancer. These high doses can destroy bone marrow. When this happens, the body is no longer able to make new blood cells. After the treatment ends, the stored stem cells are thawed and put back into the patient's bloodstream through a vein. Over time, the stem cells return to the bone, replacing the marrow and making new, normal blood cells. This type of transplant is referred to as an autologous stem cell transplant because the cells being re-infused into the body are the patient’s own.
An allogenic transplant, which uses donor stem cells, also may be an option for NHL that is not responding to initial treatments such as chemotherapy.
Immunotherapy is any treatment that boosts the patient’s own immune system to fight cancer. These treatments work to kill or slow the growth of lymphoma cells. Common categories of immunotherapy include monoclonal antibodies that target the CD20 antigen, antibodies that target the CD52 and CD30 antigens, interferon, and immunomodulating agents. Many of these immunotherapy treatments are available only through clinical trials. Rituximab (Rituxan®) is the one immunotherapy approved by the Food and Drug Administration (FDA) for the treatment of NHL.
Radioimmunotherapy combines radiation therapy and immunotherapy. A monoclonal antibody is used to deliver radiation directly to the cancer cell. There is one FDA-approved radioimmunotherapy treatment—ibritumomab tiuxetan (Zevalin®). Radioimmunotherapy may be an option for NHL patients with specific types of B-cell lymphomas. It is used more commonly in relapsed or refractory disease, when cancer comes back or remains in the bone marrow after treatment.
Targeted Therapy uses new kinds of drugs to identify and target cancer cells, causing less harm to normal cells. There are several types of targeted therapy in use today, including proteasome inhibitors, histone deacetylase (HDAC) inhibitors, and kinase inhibitors. Some work by interfering with a tumor’s ability to grow its own blood supply, while others interrupt the signaling system within the cancer cell to prevent it from growing and dividing.
Targeted therapy is given by mouth in pill form, through a vein, or as an injection. Most people with NHL are cured with chemotherapy and radiation therapy. Targeted therapies may be an option when cancer returns or no longer responds to traditional treatments. Sometimes targeted therapy is used in combination with other treatments. Brentuximab vedotin (Adcetris®) is a targeted drug that is approved for NHL after a stem cell transplant. Other targeted therapies may be available through clinical trials.
Radiation Therapy uses high-energy rays or ionizing radiation to kill cancer cells. The goal is to damage cancer cells without harming healthy tissue. To minimize damage to healthy cells, radiation doses are calculated precisely; treatment areas are carefully defined; treatment is spread out over time. After radiation treatment ends, cancer cells continue to die for days or even months. Some people with cancer only need radiation therapy. Others receive radiation before, during or after other treatments.
Radiation therapy for NHL uses a focused beam of radiation delivered from a machine outside of the body. External beam radiation is a painless procedure. Radiation may be the main treatment for some stage I and II lymphomas or used with chemotherapy for more advanced lymphomas. People receiving stem cell transplants may get whole-body radiation along with chemotherapy in an effort to kill lymphoma cells throughout the entire body, and to help prepare the body to receive the stem cells. Radiation therapy is also sometimes used to treat symptoms of lymphoma. Some radiation is available in drug form, such as the drug Zevalin®.
Side Effect Management
It helps to learn more about the side effects of treatment(s) before you begin so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are many medications available to address side effects from cancer treatment. Everyone reacts differently to treatment and experiences side effects differently. Talk to your health care team about the side effects you are experiencing so they can help you feel better. Your doctor may be able to discuss options such as lowering the dose of your treatment to help improve your quality of life if side effects persist and are not easily managed.
The following are common side effects:
- Hair loss
- Mouth sores or dry mouth
- Loss of appetite
- Nausea and vomiting
- Skin changes
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
You may also experience side effects of treatment well after your treatment has ended. It is important to talk to your doctor about long-term effects of treatment as part of your post-treatment plan.